with large polyps. This was twice as high as the rate of abnormalitie...For the family members risk was even higher when the original patient...The studies may help efforts to refine the recommendations for screeni...Of more than 14 million colonoscopies performed in 2002 in the United ...The results of the VA study support current recommendations for follow...

with large polyps. This was twice as high as the rate of abnormalities in a group of 307 patients undergoing colonoscopy for other reasons.

For the family members, risk was even higher when the original patient was male, less than 60 years old, or had polyps located deeper (more distal) in the colon. "[T]here is now evidence to suggest that first-degree relatives of patients with large adenomas may need to be screened and monitored as carefully as relatives of patients with colorectal cancer," the authors suggest. In contrast, the likelihood of finding smaller polyps was no higher for relatives versus comparison patients.

The studies may help efforts to refine the recommendations for screening colonoscopy. "If we know more about risk factors for advanced neoplasia and could electively stratify risk, then screening could be tailoredthat is, targeted to persons with high risk and away from those with low risk, who could either be examined with less invasive methods or perhaps not at all," writes Dr. Thomas F. Imperiale of Indiana University in an accompanying editorial.

Of more than 14 million colonoscopies performed in 2002 in the United States, about 40 percent were for screening while more than 20 percent were for follow-up of patients with previous suspicious polyps or colorectal cancer. Although colonoscopy is a powerful tool for screening, diagnosis, and management, it is a limited resource, according to Dr. Imperiale's editorial. If colonoscopy is not properly allocated, some patients may receive no colorectal cancer screening at all.

The results of the VA study support current recommendations for follow-up colonoscopy in patients with large polyps and other advanced neoplasia. Depending on the size, type, and number of polyps, screening may need to be performed every three yearscompared to every year for patients with colorectal cancer and every five to ten years for those with no abnormalities. In contrast, patients'/>"/>

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